Category
General Spine
Atin Saha, MSKyung Peck, PhDEric Lis, MDAndrei Holodny, MDSasan Karimi, MDPurpose
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) provides an advantage over conventional MRI in that DCE-MRI provides anatomical, physiological, and hemodynamic information about neoplastic lesions. Our aim in this study was to evaluate spinal metastases from hypervascular renal cell carcinoma (RCC) and hypovascular prostate carcinoma (PC) using a T1 DCE-MRI perfusion technique and to assess the sensitivity and specificity of the perfusion parameters obtained.
Materials & Methods
A total of 40 patients with spinal metastases and either PC or RCC as the primary tumor were studied. DCE perfusion parameters-vascular permeability (Ktrans), plasma volume (Vp), wash-in, and peak-enhancement were measured to assess their potential as discriminators of tumor histology. A Mann-Whitney U test, at a significance level of p≤0.01, was performed to quantify and compare the significances of the perfusion parameters of PC and those of RCC.
Results
Of the four perfusion parameters studied, Vp was observed to have the largest difference in mean (µ) between PC (µ=3.29/sec) and RCC metastases (µ=5.92/sec). This was followed by the peak-enhancement, Ktrans, and wash-in parameters. A Mann-Whitney U test showed a significant difference between the observed Vp values for PC and RCC lesions to the spine (p≤0.001). Similarly, peak-enhancement showed a significant difference between the two histologies (p≤0.001), as did Ktrans (p≤0.01). The receiver operating characteristic (ROC) curve showed that Vp recorded the highest area under the curve (0.867).
Conclusion
Vp was shown to be the best discriminator between spinal metastases from PC and RCC with the mean Vp of RCC metastasis being 1.8 times that of the PC lesions, thus discriminating between hyper- and hypovascular metastases, which has important clinical implications in patient care and management.
References
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